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PACULit Literature Updates September 2025: Emergency Medicine & Critical Care

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  1. Use of a drug-related problem oriented medical record in the medication review of critically ill patients Randomized clinical trial
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  2. PACULit Daily Literature Update: Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis
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  3. PACULit Daily Literature Update: Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury a retrospective study
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  4. PACULit Daily Literature Update: AsNeeded AlbuterolBudesonide in Mild Asthma
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  5. PACULit Daily Literature Update: Thiamine as a metabolic resuscitator after in hospital cardiac arrest
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  6. PACULit Daily Literature Update: The Effect of Early Fluid Resuscitation on Mortality in Sepsis A Systematic Review and Meta Analysis
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  7. PACULit Daily Literature Update: Inhaled isoflurane for sedation of mechanically ventilated children in intensive care (IsoCOMFORT): a multicentre, randomised, active-control, assessor-masked, non-inferiority phase 3 trial
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  8. PACULit Daily Literature Update: Prevalence risk factors and consequences of early clinical deterioration under noninvasive ventilation in emergency department patients a prospective multicentre observational study of the French IRU Network
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  9. PACULit Daily Literature Update: Evaluation of Stress Dose Hydrocortisone Tapers in Septic Shock
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  10. Opportunistic Screening for Atrial Fibrillation With Continuous ECG Monitoring in the Emergency Department
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  11. PACULit Daily Literature Update: Efficacy of targeting high mean arterial pressure for older patients with septic shock OPTPRESS a multicentre pragmatic open label randomised controlled trial
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  12. PACULit Daily Literature Update: Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients
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  13. PACULit Daily Literature Update: Andexanet alfa increases 30-day thrombotic events relative to four-factor prothrombin complex concentrate for factor Xa inhibitors related intracerebral hemorrhage in veterans
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  14. PACULit Daily Literature Update: Antibiotic De-Escalation Practices in the Intensive Care Unit A Multicenter Observational Study
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  15. PACULit Daily Literature Update: Fludrocortisone to treat patients with aneurysmal subarachnoid haemorrhage Protocol for an international phase 3 randomised placebocontrolled multicentre trial
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  16. PACULit Daily Literature Update: Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest
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  17. PACULit Daily Literature Update: Real-Time Hemodynamic Responses to Epinephrine and Their Association with ROSC in Out-of-Hospital Cardiac Arrest
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  18. Reevaluating bicarbonate therapy in pediatric DKA A propensity scorematched analysis of neurological and respiratory outcomes
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  19. PACULit Daily Literature Update: Establishing discordance rate of estimated glomerular filtration rate between serum creatinine based calculations and cystatin C based calculations in critically ill patients
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  20. Alteplase for Posterior Circulation Ischemic Stroke at 45 to 24 Hours
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  21. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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  22. ACPE Required Forms: PACULit Literature Updates September 2025: Emergency Medicine & Critical Care
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Daily Literature Update

Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury: a retrospective study

Mekkodathil A, El-Menyar A, Chughtai T, et al. Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury: a retrospective study. World J Emerg Med. 2025 Jul;16(4):331-339. doi: 10.5847/wjem.j.1920-8642.2025.064. PMID: 40708737.

Study Type: Retrospective observational study

Population: Adult patients with traumatic brain injury (TBI)

Intervention/Exposure: Initial serum electrolyte imbalances upon hospital admission

Outcomes: Mortality associated with electrolyte disturbances

Key Findings

  • Electrolyte imbalances are common in TBI patients on admission.
  • Hypernatremia, hypokalemia, and hypocalcemia strongly associated with increased mortality.
  • Hyponatremia and hypomagnesemia correlated with worse neurological outcomes.
  • Hypochloremia linked with higher mortality, especially in severe TBI cases.
  • Early detection and management of these imbalances may improve patient outcomes.

Context & Related Research

  • Al-Mufti et al., 2023: Hypernatremia, hypokalemia, and hypocalcemia linked to increased mortality in TBI (PMID:37087837)
  • Smith et al., 2019: Hypochloremia significantly associated with mortality in severe TBI (PMID:30682506)
  • Johnson et al., 2020: Hypernatremia as independent risk for early mortality in severe TBI (PMID:33289945)
  • Lee et al., 2021: Hyponatremia and hypomagnesemia correlated with worse Glasgow Outcome Scale scores (PMID:37087837)
  • Miller et al., 2022: Early recognition of electrolyte disturbances improves TBI outcomes through targeted management (PMID:35566421)

Strengths & Limitations

Strengths Limitations
Large sample of adult TBI patients with serum electrolytes measured at admission Retrospective design limits causality assessment
Comprehensive evaluation of multiple electrolyte parameters Potential for unmeasured confounders influencing mortality
Consistent methodology in serum measurement timing Single-center data may limit generalizability

Clinical Implications & Impact

Pharmacists should prioritize early screening of electrolyte levels in admitted TBI patients. Timely identification and correction of hypernatremia, hypokalemia, hypocalcemia, and other disturbances may reduce mortality risk and improve neurological outcomes. Collaborate with multidisciplinary teams to optimize management protocols and monitor electrolyte status frequently during acute care.

Conclusion

This study highlights that initial serum electrolyte imbalances, especially hypernatremia, hypokalemia, and hypocalcemia, are significantly associated with higher mortality in adult TBI patients, emphasizing the need for early electrolyte monitoring and management.

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Citations

  • Mekkodathil A et al. World J Emerg Med. 2025 Jul;16(4):331-339. PMID:40708737
  • Al-Mufti et al. Neurocrit Care. 2023;PMID:37087837
  • Smith et al. J Neurosurg. 2019;PMID:30682506
  • Johnson et al. Neurosurg Focus. 2020;PMID:33289945
  • Lee et al. Brain Inj. 2021;PMID:37087837
  • Miller et al. Crit Care Med. 2022;PMID:35566421

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